NPI | 1063960656 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CO60596837) |
Enumeration Date | 2016-09-13 |
Last Update Date | 2022-02-22 |