| NPI | 1487339008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1401600820) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2023-06-20 |