NPI | 1912909730 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC0912) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA414) |
101YM0800X Counselor, Mental Health (Licence: MD LC0912) | |
Enumeration Date | 2005-08-11 |
Last Update Date | 2021-02-09 |