NPI | 1598163594 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA 1517) |
Additional Taxonomies | 106H00000X Marriage & Family Therapist |
Enumeration Date | 2014-12-08 |
Last Update Date | 2014-12-08 |