| NPI | 1366657827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-11421) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-11915) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2007-07-08 |