| NPI | 1750801593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: CO PsychCandidate) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 11604-R) |
| 225C00000X Rehabilitation Counselor | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2022-04-26 |