NPI | 1962714741 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: SC 5380) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC 1304237) |
Enumeration Date | 2010-07-08 |
Last Update Date | 2014-12-09 |