NPI | 1366605305 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 1100) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 1273) |
Enumeration Date | 2008-07-09 |
Last Update Date | 2008-07-09 |