NPI | 1861119711 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 9046) |
Additional Taxonomies | 101Y00000X Counselor (Licence: LA 9046) |
Enumeration Date | 2022-10-21 |
Last Update Date | 2022-10-21 |