NPI | 1801365960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA RBT-18-70494) |
Enumeration Date | 2018-11-19 |
Last Update Date | 2021-09-28 |