| NPI | 1477863751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 4029) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2010-10-20 |
| Last Update Date | 2020-03-23 |