NPI | 1255137667 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA3520) |
Additional Taxonomies | 101YP2500X Counselor, Professional |
101Y00000X Counselor | |
101YP1600X Counselor, Pastoral | |
Enumeration Date | 2025-02-25 |
Last Update Date | 2025-09-30 |