NPI | 1760045850 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 106S00000X Behavior Technician |
106S00000X Behavior Technician | |
Enumeration Date | 2019-04-15 |
Last Update Date | 2022-03-31 |