NPI | 1972268514 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1398820720) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
Enumeration Date | 2021-11-08 |
Last Update Date | 2024-05-06 |