NPI | 1649633413 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 5278) |
Additional Taxonomies | 101Y00000X Counselor (Licence: LA 5278) |
101YM0800X Counselor, Mental Health (Licence: LA 5278) | |
Enumeration Date | 2016-03-30 |
Last Update Date | 2016-03-30 |