NPI | 1285992701 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: FL MH8639) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: FL CAP2051) |
Enumeration Date | 2012-05-03 |
Last Update Date | 2012-05-03 |