| NPI | 1538368212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-19761) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 3136) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LIAC-15209) | |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2025-02-06 |