NPI | 1275757585 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: MD LC0904) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA028) |
Enumeration Date | 2007-04-11 |
Last Update Date | 2014-02-05 |