| NPI | 1962114645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1474580722) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA R1474580722) |
| Enumeration Date | 2022-12-14 |
| Last Update Date | 2023-01-09 |