| NPI | 1437588043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 616) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AK 11-044-BHP) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 2886) | |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2016-02-17 |