NPI | 1851910343 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NV 07034-C) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner |
Enumeration Date | 2020-04-14 |
Last Update Date | 2022-05-09 |