| NPI | 1740757665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA 8641-RAC) |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2023-09-21 |