| NPI | 1265016794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1426000421) |
| Enumeration Date | 2021-05-11 |
| Last Update Date | 2025-10-28 |