NPI | 1073135075 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci45930125) |
Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
172V00000X Community Health Worker | |
Enumeration Date | 2020-05-12 |
Last Update Date | 2025-10-01 |