| NPI | 1205160108 |
|---|---|
| Former Name | RANDALL R HANSEN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-11869) |
| Enumeration Date | 2009-09-24 |
| Last Update Date | 2024-01-31 |