NPI | 1154895795 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 8567) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 8567) |
Enumeration Date | 2019-01-16 |
Last Update Date | 2024-05-06 |