NPI | 1245354604 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 875) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: MO sw003362) |
Enumeration Date | 2007-03-19 |
Last Update Date | 2007-07-08 |