NPI | 1962147041 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
101YM0800X Counselor, Mental Health | |
Enumeration Date | 2022-05-03 |
Last Update Date | 2022-05-03 |