NPI | 1720708621 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: HI 302) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI 3010-21R) |
Enumeration Date | 2022-08-31 |
Last Update Date | 2022-08-31 |