| NPI | 1477068005 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA B00003761224) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA R1282711117) |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2025-02-05 |