NPI | 1992073696 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CT 001084) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CT 000985) |
Enumeration Date | 2011-12-08 |
Last Update Date | 2012-12-07 |