NPI | 1528227519 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC 1424) |
Additional Taxonomies | 101YP2500X Counselor Professional (Licence: IL 180005464) |
Enumeration Date | 2008-06-04 |
Last Update Date | 2011-03-21 |