NPI | 1932756038 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 0151611) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CAD0218661) |
Enumeration Date | 2019-08-22 |
Last Update Date | 2021-09-15 |