NPI | 1780233734 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 106S00000X Behavior Technician |
175T00000X Peer Specialist | |
Enumeration Date | 2019-09-11 |
Last Update Date | 2021-06-02 |