| NPI | 1336410380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 5382) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2025-03-12 |