NPI | 1124792650 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 7475) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IN 24973) |
101YM0800X Counselor, Mental Health (Licence: CA 7475) | |
Enumeration Date | 2021-08-07 |
Last Update Date | 2021-08-07 |