NPI | 1891988192 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 12053115) |
Additional Taxonomies | 101Y00000X Counselor |
Enumeration Date | 2007-08-21 |
Last Update Date | 2013-01-31 |