NPI | 1053443614 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225400000X Rehabilitation Practitioner |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2007-03-09 |
Last Update Date | 2023-06-28 |