NPI | 1174766885 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM T-0121341) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0121221) |
Enumeration Date | 2009-04-10 |
Last Update Date | 2009-04-10 |