NPI | 1760125843 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A057340620) |
Additional Taxonomies | 101YP1600X Counselor, Pastoral |
Enumeration Date | 2022-04-18 |
Last Update Date | 2022-04-18 |