NPI | 1659464592 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 0716) |
Additional Taxonomies | 104100000X Social Worker (Licence: KY 3666) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2007-07-08 |