| NPI | 1689950560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LAC-20252) |
| Additional Taxonomies | 2355S0801X Specialist/Technologist, Speech-Language Assistant (Licence: AZ SLPA7433) |
| Enumeration Date | 2011-10-24 |
| Last Update Date | 2023-07-11 |