| NPI | 1952251316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1606820425) |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| Enumeration Date | 2026-02-03 |
| Last Update Date | 2026-04-14 |