| NPI | 1396114013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA C037080316) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R117961214) |
| Enumeration Date | 2015-09-23 |
| Last Update Date | 2022-07-21 |