NPI | 1982028536 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ LPC-14252) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LPC-14252) |
Enumeration Date | 2014-02-18 |
Last Update Date | 2014-02-18 |