NPI | 1902902059 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT 970) |
Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MT 942-LCPC) |
Enumeration Date | 2006-09-16 |
Last Update Date | 2007-07-08 |