| NPI | 1699366849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-155282) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LAC-20776) |
| Enumeration Date | 2021-01-31 |
| Last Update Date | 2023-12-04 |