| NPI | 1437741386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1436370721) |
| Additional Taxonomies | 167G00000X Licensed Psychiatric Technician (Licence: CA 37823) |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2024-04-04 |