NPI | 1598230484 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: WI 9016-123) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 15934-132) |
Enumeration Date | 2018-10-08 |
Last Update Date | 2018-10-08 |