NPI | 1184968091 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: ID LPC-4990) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ID LPC-4990) |
Enumeration Date | 2012-11-15 |
Last Update Date | 2021-04-08 |