NPI | 1184817264 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI SARF 821679) |
Additional Taxonomies | 101Y00000X Counselor (Licence: MI 6401003498) |
Enumeration Date | 2007-08-22 |
Last Update Date | 2007-08-22 |