| NPI | 1053006197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1596270125) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: CA E120558) |
| Enumeration Date | 2023-04-05 |
| Last Update Date | 2025-01-24 |