| NPI | 1255049466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1553680324) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2022-11-08 |
| Last Update Date | 2024-10-04 |