| NPI | 1831290444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC12099) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-10344) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LPC12099) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2007-09-13 |