| NPI | 1104349646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: CA 122995111) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2022-07-21 |