NPI | 1962791210 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: ME LC5193) |
Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NC LCAS-23750) |
Enumeration Date | 2011-04-06 |
Last Update Date | 2019-08-19 |