| NPI | 1720747058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 278085) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: DE CD-0010146) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OH LICDC.162165) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 306010) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-27911) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NH 1182) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 12258) | |
| Enumeration Date | 2021-12-14 |
| Last Update Date | 2023-11-22 |