NPI | 1760030878 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii063430123) |
Enumeration Date | 2019-09-01 |
Last Update Date | 2024-05-29 |