| NPI | 1932446259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: AK 3833) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 3833) |
| 101YM0800X Counselor, Mental Health (Licence: AK 3833) | |
| Enumeration Date | 2013-01-07 |
| Last Update Date | 2014-08-04 |