NPI | 1598279754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: GA APC006151) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA 015786) |
Enumeration Date | 2017-11-27 |
Last Update Date | 2017-11-27 |