NPI | 1568141067 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA 15750) |
Enumeration Date | 2023-07-13 |
Last Update Date | 2024-03-29 |