NPI | 1851569925 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 106H00000X Marriage & Family Therapist (Licence: AZ 10106) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 1666) |
Enumeration Date | 2008-02-12 |
Last Update Date | 2008-02-12 |