NPI | 1487710547 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MA 270) |
Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MA 3639) |
Enumeration Date | 2006-12-30 |
Last Update Date | 2008-05-16 |