| NPI | 1366048514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 2213422-II) |
| Additional Taxonomies | 374700000X Technician |
| Enumeration Date | 2020-12-11 |
| Last Update Date | 2023-09-01 |