NPI | 1255049466 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1553680324) |
Additional Taxonomies | 101Y00000X Counselor |
Enumeration Date | 2022-11-08 |
Last Update Date | 2024-10-04 |