| NPI | 1598896300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 090315) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA CADC-II A8488404) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2019-11-18 |