NPI | 1255896627 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: R7339) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R7339) |
Enumeration Date | 2019-02-09 |
Last Update Date | 2019-02-09 |