| NPI | 1578814737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AK 100058) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 3720) |
| Enumeration Date | 2012-09-28 |
| Last Update Date | 2020-10-09 |