| NPI | 1740858299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA APCC7712) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Apcc7712) |
| 101YM0800X Counselor, Mental Health (Licence: CA Apcc7712) | |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-06-11 |