NPI | 1275650749 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 10540) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ 11790) |
103TC0700X Psychologist, Clinical (Licence: AZ 3015) | |
Enumeration Date | 2007-03-22 |
Last Update Date | 2007-07-08 |