| NPI | 1306271622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A044950717) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2013-09-05 |
| Last Update Date | 2019-04-22 |