NPI | 1164089041 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA MFC46844) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA MFC46844) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA MFC46844) | |
Enumeration Date | 2019-05-25 |
Last Update Date | 2019-05-25 |