NPI | 1194806331 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor Professional (Licence: WI 3220-125) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: WI 151) |
Enumeration Date | 2006-10-17 |
Last Update Date | 2018-08-03 |