NPI | 1942721485 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC P016042) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 23146) |
101YM0800X Counselor, Mental Health (Licence: NC PO12034) | |
Enumeration Date | 2017-07-06 |
Last Update Date | 2021-11-11 |