| NPI | 1720868029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA APCC15767) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 16352) |
| Enumeration Date | 2023-10-03 |
| Last Update Date | 2024-02-23 |