| NPI | 1952705899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R4280115) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2020-11-23 |