| NPI | 1053406843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LPC-2484) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-2484) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |