| NPI | 1881166635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NE LIMHP2609) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NE LPC2644) |
| 101YP2500X Counselor, Professional (Licence: AK PCOP881) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 1435) | |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2021-09-16 |