NPI | 1629854849 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: TX 86386) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 16684) |
Enumeration Date | 2023-09-04 |
Last Update Date | 2023-09-04 |