NPI | 1083108153 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CADC-30944) |
Additional Taxonomies | 101Y00000X Counselor |
Enumeration Date | 2018-06-21 |
Last Update Date | 2024-06-18 |