NPI | 1508036716 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: GA LPC004213) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC LPC2317) |
Enumeration Date | 2008-03-04 |
Last Update Date | 2008-03-04 |