| NPI | 1578188280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 14100) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2020-06-09 |
| Last Update Date | 2026-04-30 |