NPI | 1225162696 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CO 2854) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 6118) |
101YM0800X Counselor, Mental Health (Licence: CO 2854) | |
Enumeration Date | 2007-03-15 |
Last Update Date | 2022-07-11 |