NPI | 1699921130 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA C3511465) |
Additional Taxonomies | 101Y00000X Counselor |
Enumeration Date | 2008-08-15 |
Last Update Date | 2022-07-21 |