NPI | 1225083397 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WI 2213) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1062) |
Enumeration Date | 2006-05-24 |
Last Update Date | 2020-09-15 |