NPI | 1598741233 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 9248) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LCi12250518) |
101YP2500X Counselor, Professional (Licence: NC 4813) | |
Enumeration Date | 2005-12-15 |
Last Update Date | 2024-09-06 |