NPI | 1790426674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-25738) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NC A18771) |
Enumeration Date | 2022-04-05 |
Last Update Date | 2023-08-22 |