| NPI | 1326305079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 16029) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2023-10-02 |