NPI | 1407249063 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WA MC60593925) |
Additional Taxonomies | 101Y00000X Counselor |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 15-07-2-1) | |
101YM0800X Counselor, Mental Health (Licence: CA 10311) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2015-03-06 |
Last Update Date | 2025-05-27 |