NPI | 1104317254 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci31541220) |
Additional Taxonomies | 374700000X Technician |
Enumeration Date | 2018-05-24 |
Last Update Date | 2023-08-29 |