NPI | 1679638720 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA ccgc 113) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: LA lcsw 3782) |
Enumeration Date | 2006-12-27 |
Last Update Date | 2007-07-08 |