NPI | 1720457062 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101Y00000X Counselor (Licence: NM T-CTL0220731) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CSA0221391) |
Enumeration Date | 2015-09-16 |
Last Update Date | 2022-08-10 |