NPI | 1518623115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA CI31631220) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2021-11-09 |
Last Update Date | 2023-10-12 |