| NPI | 1669695862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii3551214) |
| Additional Taxonomies | 225C00000X Rehabilitation Counselor |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2019-12-18 |