NPI | 1073857785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AL .908) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AL NCC29568) |
Enumeration Date | 2012-11-19 |
Last Update Date | 2012-11-19 |