NPI | 1194042754 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: IL 180.005968) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: IL 180.005968) |
Enumeration Date | 2010-04-22 |
Last Update Date | 2010-05-11 |