NPI | 1295248474 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: VA 0701003652) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0711000440) |
101YM0800X Counselor, Mental Health (Licence: GA 004398) | |
Enumeration Date | 2017-11-10 |
Last Update Date | 2023-11-17 |