| NPI | 1154893899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: LA LAC-5137) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: LA PLC8995) |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2024-03-05 |