| NPI | 1801268693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii051530218) |
| Enumeration Date | 2015-10-20 |
| Last Update Date | 2025-06-03 |