NPI | 1770188310 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
Enumeration Date | 2020-12-02 |
Last Update Date | 2020-12-04 |