NPI | 1366166365 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1498030223) |
Additional Taxonomies | 106S00000X Behavior Technician |
Enumeration Date | 2022-10-03 |
Last Update Date | 2024-11-08 |