NPI | 1902244403 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 952838006) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA 952838006) |
Enumeration Date | 2013-06-06 |
Last Update Date | 2013-06-06 |