| NPI | 1770740003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 14393) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2023-12-04 |