NPI | 1679179949 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1418570221) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2020-12-10 |
Last Update Date | 2022-03-17 |