NPI | 1619436979 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 21-05-10147) |
Additional Taxonomies | 106S00000X Behavior Technician |
Enumeration Date | 2019-03-17 |
Last Update Date | 2025-05-20 |