NPI | 1437502788 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 168131III) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2016-07-21 |
Last Update Date | 2024-07-10 |