| NPI | 1093352940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 18614) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA B00002410322) |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2025-02-10 |