NPI | 1568023877 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA Aii31190619) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA Aii31190619) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii31190619) | |
Enumeration Date | 2019-06-26 |
Last Update Date | 2024-05-22 |