| NPI | 1992076145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 191199AP) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 1206182052) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LCi11210418) | |
| 103TA0400X Psychologist, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2024-02-06 |