NPI | 1881974020 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-0769) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: AZ LPC-2419) |
Enumeration Date | 2011-08-19 |
Last Update Date | 2011-08-19 |