| NPI | 1285187567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 102L00000X Psychoanalyst (Licence: AZ LAC-15674) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ LAC-15674) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LAC-15674) | |
| 101YM0800X Counselor, Mental Health (Licence: AZ LAC-15674) | |
| Enumeration Date | 2016-08-03 |
| Last Update Date | 2016-08-03 |