| NPI | 1215305883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-13784) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LPC-13784) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-11880) | |
| 101YM0800X Counselor, Mental Health (Licence: AZ LPC-13784) | |
| Enumeration Date | 2015-09-12 |
| Last Update Date | 2015-09-12 |