| NPI | 1699327296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LAC-16888) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LAC-16888) |
| 101Y00000X Counselor (Licence: AZ LAC-16888) | |
| 101YM0800X Counselor, Mental Health (Licence: AZ LAC-16888) | |
| Enumeration Date | 2019-07-12 |
| Last Update Date | 2019-07-12 |