NPI | 1801051867 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NM C-11557) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 4878) |
Enumeration Date | 2008-07-18 |
Last Update Date | 2021-10-13 |