| NPI | 1942925441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA RA9931120) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: CA RACPS9941120) |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2022-10-06 |