| NPI | 1174164222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 7478) |
| Enumeration Date | 2019-09-30 |
| Last Update Date | 2021-10-05 |