NPI | 1174780761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: VA 070100371) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 070100371) |
Enumeration Date | 2008-05-21 |
Last Update Date | 2022-07-27 |