| NPI | 1760230981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A063000723) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| 251S00000X (Licence: CA 24-CCHW-00011) | |
| Enumeration Date | 2024-05-13 |
| Last Update Date | 2024-09-06 |