NPI | 1710130208 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C3149) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 99-07-07) |
Enumeration Date | 2008-10-28 |
Last Update Date | 2019-02-27 |