NPI | 1477820132 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: TX 86294) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1204) |
101YP2500X Counselor, Professional (Licence: LA 5018) | |
Enumeration Date | 2011-11-23 |
Last Update Date | 2023-11-08 |