| NPI | 1790858033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ND 1917) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: ND 1364-6-15-24) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2026-05-29 |