NPI | 1922394410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A2006598) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LR190311) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ LISAC 11522) | |
Enumeration Date | 2011-06-22 |
Last Update Date | 2024-11-03 |