| NPI | 1306435797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A058671120) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA A058671120) |
| 101YM0800X Counselor, Mental Health (Licence: CA A058671120) | |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2022-01-31 |