| NPI | 1083257703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion (Licence: CA Ci37650223) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci37650223) |
| Enumeration Date | 2019-10-25 |
| Last Update Date | 2025-06-02 |