| NPI | 1558726497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA M0912170943) |
| Enumeration Date | 2015-12-18 |
| Last Update Date | 2025-04-04 |