NPI | 1497366686 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 14701) |
Enumeration Date | 2020-08-12 |
Last Update Date | 2021-05-11 |