| NPI | 1841638582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-15546) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LASAC-13288) |
| 101Y00000X Counselor (Licence: AZ LAC-14063) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2017-06-09 |