NPI | 1043032337 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: LPCC.0021335) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ADDC.0000399) |
Enumeration Date | 2024-10-28 |
Last Update Date | 2024-10-28 |