NPI | 1639635808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 225C00000X Rehabilitation Counselor (Licence: PR 1625) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PR CAT-IV-52021) |
Enumeration Date | 2019-02-13 |
Last Update Date | 2019-07-16 |