NPI | 1154419018 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 1721) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MA 653) |
Enumeration Date | 2006-10-10 |
Last Update Date | 2007-07-08 |