NPI | 1689634412 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 5986) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CO 3111) |
Enumeration Date | 2006-03-24 |
Last Update Date | 2007-07-08 |