| NPI | 1639691520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 8402) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MN 303472) |
| 104100000X Social Worker (Licence: CA 85096) | |
| Enumeration Date | 2017-07-12 |
| Last Update Date | 2022-07-21 |