| NPI | 1205066347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA AII7971214) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2025-04-29 |