NPI | 1417096017 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 225400000X Rehabilitation Practitioner |
Enumeration Date | 2007-02-06 |
Last Update Date | 2012-11-30 |