NPI | 1790475143 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: SC CS-20113) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: PA 5474) |
Enumeration Date | 2023-05-09 |
Last Update Date | 2023-05-09 |