NPI | 1275837544 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA C3721214) |
Additional Taxonomies | 101Y00000X Counselor |
Enumeration Date | 2010-12-30 |
Last Update Date | 2018-09-11 |