NPI | 1417240383 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 111806) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2011-05-25 |
Last Update Date | 2022-11-17 |