NPI | 1114631314 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 106S00000X Behavior Technician |
Enumeration Date | 2023-01-11 |
Last Update Date | 2024-05-01 |