NPI | 1295827376 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: ND 52421506188) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1535) |
Enumeration Date | 2006-09-28 |
Last Update Date | 2013-08-20 |