NPI | 1346820032 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CDCA.176881) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2021-04-08 |
Last Update Date | 2021-06-02 |