NPI | 1154462273 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 25115) |
Enumeration Date | 2007-02-09 |
Last Update Date | 2011-02-22 |