NPI | 1952466658 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: NC 4198) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 846) |
Enumeration Date | 2006-12-25 |
Last Update Date | 2019-03-25 |