NPI | 1295857209 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 528) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: MT 333) |
Enumeration Date | 2007-04-03 |
Last Update Date | 2007-07-08 |