NPI | 1386881795 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101Y00000X Counselor (Licence: MA 16) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 83) |
Enumeration Date | 2009-01-08 |
Last Update Date | 2015-10-07 |