NPI | 1790059079 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MI 2-01119) |
Additional Taxonomies | 101YM0800X Counselor, Mental Health |
Enumeration Date | 2012-03-03 |
Last Update Date | 2012-03-03 |