NPI | 1619306289 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LCi10970318) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 5465630291) |
Enumeration Date | 2013-11-04 |
Last Update Date | 2023-03-07 |