| NPI | 1013959139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-11595) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-10674) |
| 101YP2500X Counselor, Professional (Licence: AZ LPC-11595) | |
| 101Y00000X Counselor (Licence: AZ LPC-10595) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2008-05-29 |