NPI | 1629780770 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R8780) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-2191) |
Enumeration Date | 2022-12-20 |
Last Update Date | 2024-05-01 |