NPI | 1174302897 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 164X00000X Licensed Vocational Nurse (Licence: CA 703378) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
101YA0400X Counselor, Addiction (Substance Use Disorder) | |
Enumeration Date | 2023-09-22 |
Last Update Date | 2024-10-16 |