| NPI | 1972716959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AK 1331) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2020-06-23 |