| NPI | 1154918134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 123456789) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: AK 142653) |
| Enumeration Date | 2020-12-24 |
| Last Update Date | 2023-04-19 |