| NPI | 1104317254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA CI31541220) |
| Additional Taxonomies | 374700000X Technician |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2023-08-29 |