NPI | 1164991931 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NV 02578-I) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii054680418) |
Enumeration Date | 2018-11-21 |
Last Update Date | 2021-09-13 |