NPI | 1184766412 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA051) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: MD LCA051) |
Enumeration Date | 2007-02-13 |
Last Update Date | 2007-11-07 |