NPI | 1376661157 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AR P1106045) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 0288L) |
Enumeration Date | 2007-03-27 |
Last Update Date | 2011-07-11 |