NPI | 1275698748 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WI 1813) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WI 4129-123) |
Enumeration Date | 2006-12-26 |
Last Update Date | 2007-07-08 |