| NPI | 1962848093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 7537) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA B1006171257) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 156325 I) | |
| Enumeration Date | 2013-05-15 |
| Last Update Date | 2025-04-11 |