| NPI | 1467772194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC - 11495) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC - 10960) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2010-06-04 |