NPI | 1073888442 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1470810622) |
Additional Taxonomies | 164X00000X Licensed Vocational Nurse (Licence: CA VN235277) |
Enumeration Date | 2012-03-18 |
Last Update Date | 2022-07-20 |