NPI | 1891153102 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: UT 10382594-3501) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
101YP2500X Counselor, Professional | |
Enumeration Date | 2016-02-01 |
Last Update Date | 2023-05-24 |