NPI | 1699219584 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: PA PC012114) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA BH001757) |
Enumeration Date | 2016-12-12 |
Last Update Date | 2020-12-15 |