| NPI | 1457070187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist (Licence: CA 11024) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 11024) |
| Enumeration Date | 2022-08-25 |
| Last Update Date | 2025-03-19 |