NPI | 1538389275 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 4936) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 725) |
101YP2500X Counselor, Professional (Licence: NC 4936) | |
Enumeration Date | 2007-04-26 |
Last Update Date | 2014-06-05 |