NPI | 1093435711 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB20230785) |
Enumeration Date | 2022-09-01 |
Last Update Date | 2025-07-23 |