NPI | 1306490065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
101Y00000X Counselor | |
Enumeration Date | 2019-07-30 |
Last Update Date | 2024-09-19 |