| NPI | 1619238375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA aii053610318) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA Y1002121424) |
| 374700000X Technician (Licence: CA Y1002121424) | |
| Enumeration Date | 2012-05-30 |
| Last Update Date | 2024-06-05 |