| NPI | 1891426565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 109901) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 15745-RAC) |
| 104100000X Social Worker (Licence: CA 109901) | |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2022-11-29 |