| NPI | 1811230980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 133051 II) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA 3051-i) |
| Enumeration Date | 2013-03-27 |
| Last Update Date | 2013-08-22 |