NPI | 1235474909 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC 2413A) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: NC 2413A) |
Enumeration Date | 2012-12-06 |
Last Update Date | 2018-03-17 |