| NPI | 1275885949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR A465) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA NCPT2014-199) |
| Enumeration Date | 2012-10-05 |
| Last Update Date | 2023-10-12 |