NPI | 1689456089 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1417450121) |
Additional Taxonomies | 175T00000X Peer Specialist |
Enumeration Date | 2023-10-19 |
Last Update Date | 2024-06-14 |