NPI | 1124436415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 15-04-15) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2014-07-30 |
Last Update Date | 2017-04-28 |