| NPI | 1346568920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA RS5862) |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2022-07-21 |