NPI | 1629409289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-17155) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-15078) |
Enumeration Date | 2013-12-09 |
Last Update Date | 2024-07-16 |