NPI | 1871859603 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 3337) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 8466) |
101YP2500X Counselor, Professional (Licence: NC 8466) | |
Enumeration Date | 2012-04-05 |
Last Update Date | 2015-10-16 |