NPI | 1154810208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 1997) |
Additional Taxonomies | 175T00000X Peer Specialist |
Enumeration Date | 2018-05-03 |
Last Update Date | 2024-05-13 |