| NPI | 1801726468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA Ci32690421) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci32690421) |
| Enumeration Date | 2026-05-22 |
| Last Update Date | 2026-06-08 |