| NPI | 1598489932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA CI39820823) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1485310922) |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2023-08-16 |