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 |