| NPI | 1437607983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 469122) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: CA 469122) | |
| 163WC1400X Registered Nurse, College Health (Licence: CA 469122) | |
| Enumeration Date | 2016-09-13 |
| Last Update Date | 2018-07-16 |