| NPI | 1386073773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: AZ LPC-15869) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: AZ 2077) |
| 101YM0800X Counselor Mental Health (Licence: AZ 274970) | |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2015-12-05 |