| NPI | 1053205195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA r151200723) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1512800723) |
| 101YM0800X Counselor, Mental Health (Licence: CA 11908) | |
| Enumeration Date | 2025-06-04 |
| Last Update Date | 2025-06-04 |