| NPI | 1447748264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 139752) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA SUDCC9692) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2023-09-12 |