| NPI | 1265396691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RT1420681025) |
| Enumeration Date | 2025-12-10 |
| Last Update Date | 2026-02-25 |