NPI | 1790735629 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: HI 1110-02) |
Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: HI 3301) |
Enumeration Date | 2006-05-11 |
Last Update Date | 2007-07-08 |