NPI | 1013552298 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: TX 79370) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 14343) |
Enumeration Date | 2019-11-12 |
Last Update Date | 2024-01-30 |