NPI | 1710021035 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: MD L1492) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA386) |
Enumeration Date | 2007-02-19 |
Last Update Date | 2019-10-23 |