| NPI | 1609272582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 11066) |
| Additional Taxonomies | 104100000X Social Worker |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2014-11-05 |
| Last Update Date | 2021-01-13 |