| NPI | 1124703798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1514550723) |
| Additional Taxonomies | 174H00000X Health Educator |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2023-07-21 |