| NPI | 1902017478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A7460112) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: CA 128289) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2007-05-25 |
| Last Update Date | 2013-05-09 |