| NPI | 1346717568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA A044200417) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A044200417) |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2020-05-21 |