| NPI | 1679715338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 86) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AK 86) |
| 101YP2500X Counselor, Professional (Licence: AK 86) | |
| Enumeration Date | 2009-03-27 |
| Last Update Date | 2009-03-27 |