NPI | 1720264302 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: TX 70020) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: VA 0710102179) |
Enumeration Date | 2008-01-14 |
Last Update Date | 2024-03-12 |