| NPI | 1770810897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RW3506) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A07220315) | |
| Enumeration Date | 2009-11-10 |
| Last Update Date | 2025-05-07 |