| NPI | 1700355633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1561100524) |
| Additional Taxonomies | 106S00000X Behavior Technician (Licence: CA R1561100524) |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2025-05-05 |