NPI | 1538669171 |
---|---|
Other Name | JACK THOMAS |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO NLC.0108047) |
Enumeration Date | 2018-02-20 |
Last Update Date | 2018-02-20 |