NPI | 1720350937 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: CO CSW-439) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB-7281) |
Enumeration Date | 2012-02-02 |
Last Update Date | 2012-02-02 |