NPI | 1770122384 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 10180) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2019-12-30 |
Last Update Date | 2019-12-30 |