NPI | 1659677219 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 4953588-6006) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2011-01-31 |
Last Update Date | 2023-11-21 |