NPI | 1346841665 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC12376) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA3093) |
Enumeration Date | 2020-11-03 |
Last Update Date | 2022-09-06 |