NPI | 1083951388 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 2176) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CT 2176) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 2176) | |
101YM0800X Counselor, Mental Health (Licence: CT 2176) | |
Enumeration Date | 2013-01-08 |
Last Update Date | 2024-03-22 |