NPI | 1013436062 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MS 2281) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 13744) |
101YP2500X Counselor, Professional (Licence: TX 75012) | |
Enumeration Date | 2017-09-11 |
Last Update Date | 2019-10-07 |