| NPI | 1740773100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1194430315) |
| Additional Taxonomies | 101YP2500X Counselor Professional (Licence: CA R1194430315) |
| Enumeration Date | 2018-06-11 |
| Last Update Date | 2018-06-11 |