| NPI | 1164472924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AK 420) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AK 420) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 420) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-10-17 |