| NPI | 1558079863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 14240) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101Y00000X Counselor (Licence: CA 1558079863) | |
| Enumeration Date | 2022-11-07 |
| Last Update Date | 2023-08-14 |