NPI | 1346682663 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MO 2013010505) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 2013010505) |
101YM0800X Counselor, Mental Health (Licence: MO 2013010505) | |
Enumeration Date | 2013-07-28 |
Last Update Date | 2013-07-28 |