NPI | 1942321831 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: FL 5178) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2007-04-02 |
Last Update Date | 2015-03-10 |