NPI | 1124385208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 11020115) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 60077) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 015018) | |
Enumeration Date | 2012-04-13 |
Last Update Date | 2012-04-13 |