NPI | 1336466374 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 5425) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CO 5425) |
Enumeration Date | 2010-04-30 |
Last Update Date | 2010-04-30 |