| NPI | 1184244121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 82921) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: CA 82921) |
| Enumeration Date | 2020-04-20 |
| Last Update Date | 2025-05-27 |