| NPI | 1598427551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 12144) |
| Additional Taxonomies | 104100000X Social Worker |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2025-05-23 |