| NPI | 1023886561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA C47811214) |
| Enumeration Date | 2023-12-14 |
| Last Update Date | 2025-04-14 |