| NPI | 1033760103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1432730621) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-09-20 |
| Last Update Date | 2025-07-22 |