NPI | 1295071389 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 167G00000X Licensed Psychiatric Technician |
Enumeration Date | 2012-12-18 |
Last Update Date | 2020-04-27 |