| NPI | 1598566200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1602980325) |
| Additional Taxonomies | 363AM0700X Physician Assistant Medical (Licence: CA CMAC-8054) |
| Enumeration Date | 2025-03-20 |
| Last Update Date | 2025-07-23 |