| NPI | 1568933307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA CI26110618) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA CI266110618) |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2023-03-07 |