| NPI | 1932636487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CAODC6453) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 4376-i) | |
| Enumeration Date | 2017-05-15 |
| Last Update Date | 2018-12-20 |