NPI | 1972299402 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA C058430618) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2023-04-17 |
Last Update Date | 2023-04-17 |