| NPI | 1922647346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1367361019) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: CA RADT78265) |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2022-02-22 |