| NPI | 1710654561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA R1437370721) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2021-08-30 |