NPI | 1184830275 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 3396) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 5) |
Enumeration Date | 2007-05-15 |
Last Update Date | 2019-03-03 |