NPI | 1679104053 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 101Y00000X Counselor |
390200000X Student in an Organized Health Care Education/Training Program | |
106S00000X Behavior Technician (Licence: CA A064740724) | |
172V00000X Community Health Worker | |
Enumeration Date | 2020-02-04 |
Last Update Date | 2025-07-23 |