NPI | 1053742957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 1452) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA 1452) |
Enumeration Date | 2013-12-03 |
Last Update Date | 2019-03-19 |