| NPI | 1720799448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1424050421) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA R1424050421) |
| Enumeration Date | 2022-12-13 |
| Last Update Date | 2023-01-27 |