| NPI | 1871842237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA B1003311134) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CATUS1-1362-010914S) |
| Enumeration Date | 2012-08-31 |
| Last Update Date | 2012-08-31 |