| NPI | 1629667522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1457530222) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2021-01-14 |
| Last Update Date | 2022-08-30 |