NPI | 1366745937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: NE 4528) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NE 612) |
101YP2500X Counselor, Professional (Licence: NE 2202) | |
Enumeration Date | 2010-12-21 |
Last Update Date | 2016-04-07 |