NPI | 1407091945 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ LPC-11725) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LPC-11725) |
Enumeration Date | 2008-12-12 |
Last Update Date | 2008-12-12 |