NPI | 1104253673 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 718) |
Additional Taxonomies | 101Y00000X Counselor (Licence: KS 718) |
Enumeration Date | 2013-09-30 |
Last Update Date | 2013-09-30 |