NPI | 1619418761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 9694) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MA 9694) |
101YM0800X Counselor, Mental Health (Licence: MA 9694) | |
Enumeration Date | 2017-03-09 |
Last Update Date | 2019-02-22 |