| NPI | 1003307679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 21561) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: CA OT15410) |
| Enumeration Date | 2018-05-19 |
| Last Update Date | 2025-06-24 |