| NPI | 1750655825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 9377) |
| Additional Taxonomies | 261QS1000X Clinic/Center, Student Health |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2012-03-06 |
| Last Update Date | 2026-04-14 |