NPI | 1306435797 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A058671120) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA A058671120) |
101YM0800X Counselor, Mental Health (Licence: CA A058671120) | |
Enumeration Date | 2021-01-11 |
Last Update Date | 2022-01-31 |