| NPI | 1801460985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion (Licence: CA 136782) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1424280421) |
| Enumeration Date | 2021-05-13 |
| Last Update Date | 2025-09-03 |