NPI | 1649723669 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA365) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MD LCA365) |
Enumeration Date | 2016-07-26 |
Last Update Date | 2016-07-26 |