NPI | 1295856045 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NH 543) |
Additional Taxonomies | 1041C0700X Social Worker Clinical (Licence: MA 110269) |
Enumeration Date | 2007-04-02 |
Last Update Date | 2007-07-08 |