| NPI | 1568851392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO ACB.0008070) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP 60144815) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 13-R-26) | |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2019-06-05 |