| NPI | 1366076408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: SC AADC-2128) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: SC 8981) |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2026-04-28 |