| NPI | 1912692310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ supervised) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: AZ supervised) |
| Enumeration Date | 2023-04-10 |
| Last Update Date | 2023-04-10 |