| NPI | 1952975500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 10169) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 390007BN) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2021-05-18 |