NPI | 1619238375 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA aii053610318) |
Additional Taxonomies | 101Y00000X Counselor (Licence: CA Y1002121424) |
374700000X Technician (Licence: CA Y1002121424) | |
Enumeration Date | 2012-05-30 |
Last Update Date | 2024-06-05 |