NPI | 1043604408 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ID LPC-4409) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID LPC-4409) |
101YM0800X Counselor, Mental Health (Licence: ID LPC-4409) | |
Enumeration Date | 2015-03-24 |
Last Update Date | 2015-03-24 |