| NPI | 1487196721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 7704-R) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 32687) |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2016-11-16 |