| NPI | 1245798016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CA LCI04511115) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA LCI04511115) | |
| Enumeration Date | 2019-03-11 |
| Last Update Date | 2023-11-29 |