| NPI | 1952816563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA CI38800623) |
| Additional Taxonomies | 374700000X Technician |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2023-09-03 |