| NPI | 1932564697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC-15039) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: AZ lac-15368) |
| Enumeration Date | 2015-12-23 |
| Last Update Date | 2015-12-23 |