NPI | 1215113360 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 3195) |
Additional Taxonomies | 101Y00000X Counselor (Licence: NC 3195) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3195) | |
Enumeration Date | 2008-01-18 |
Last Update Date | 2008-01-18 |