NPI | 1851509368 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MD LCA340) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MD LCO979) |
Enumeration Date | 2007-05-18 |
Last Update Date | 2007-07-08 |