NPI | 1457424640 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: MA 1811) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MA 816) |
Enumeration Date | 2006-11-16 |
Last Update Date | 2024-08-31 |