| NPI | 1942773023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 6180) |
| Additional Taxonomies | 374700000X Technician |
| Enumeration Date | 2019-01-10 |
| Last Update Date | 2025-05-06 |