NPI | 1417250093 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD AC0544) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN C-2739) |
Enumeration Date | 2010-12-21 |
Last Update Date | 2010-12-21 |