NPI | 1124668181 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: AZ 15151) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 15151) |
Enumeration Date | 2020-01-08 |
Last Update Date | 2021-03-05 |