| NPI | 1659160042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 20255) |
| Enumeration Date | 2025-05-02 |
| Last Update Date | 2025-10-09 |