| NPI | 1659859221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AK 136552) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 4326) |
| 101YP2500X Counselor, Professional | |
| Enumeration Date | 2018-08-05 |
| Last Update Date | 2024-05-09 |