NPI | 1548490659 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM 3730) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: NM 3730) |
Enumeration Date | 2009-07-23 |
Last Update Date | 2009-07-23 |