NPI | 1376932293 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACD.0001090) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2015-01-15 |
Last Update Date | 2018-09-13 |