| NPI | 1558860270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 1558860270) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1303650418) | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-02-08 |
| Last Update Date | 2022-04-13 |