| NPI | 1174709752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-10912) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: AZ LISAC-10912) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2018-08-22 |