| NPI | 1700766987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 12178) |
| Additional Taxonomies | 101YP1600X Counselor, Pastoral |
| Enumeration Date | 2025-09-06 |
| Last Update Date | 2025-09-06 |