NPI | 1942645916 |
---|---|
Former Name | EINSTEIN HICKMAN |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: OR C5178) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-R-08) |
Enumeration Date | 2013-05-06 |
Last Update Date | 2020-01-12 |