| NPI | 1144378027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 8943SUDCC) |
| Additional Taxonomies | 276400000X Rehabilitation, Substance Use Disorder Unit (Licence: CA 02-009648) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2021-06-02 |