NPI | 1386025922 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: LA 3419) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 952) |
101YP2500X Counselor, Professional (Licence: NC 8762) | |
Enumeration Date | 2015-06-09 |
Last Update Date | 2023-06-21 |