| NPI | 1861728602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AR 1559) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RA858109) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: PA 119945) | |
| Enumeration Date | 2009-10-29 |
| Last Update Date | 2019-11-14 |