| NPI | 1275211930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 1460) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AK 1460) |
| Enumeration Date | 2023-07-11 |
| Last Update Date | 2023-07-17 |