| NPI | 1073652707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii57000518) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA D30769) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2024-03-19 |