| NPI | 1942894621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1373181219) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2025-05-15 |