| NPI | 1598741233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA 9248) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LCi12250518) |
| 101YP2500X Counselor, Professional (Licence: NC 4813) | |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2024-09-06 |