| NPI | 1346578986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: AK 121067) |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2022-04-08 |