| NPI | 1619306289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA LCI10970318) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA 5465630291) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2023-03-07 |