NPI | 1871842237 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA B1003311134) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CATUS1-1362-010914S) |
Enumeration Date | 2012-08-31 |
Last Update Date | 2012-08-31 |