NPI | 1639393960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 29) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CO 992026) |
Enumeration Date | 2007-04-11 |
Last Update Date | 2007-07-08 |