| NPI | 1013331602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1402610820) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 2300) |
| Enumeration Date | 2014-02-18 |
| Last Update Date | 2020-10-02 |