| NPI | 1003225897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC LCAS-30598) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 67295) |
| Enumeration Date | 2014-08-06 |
| Last Update Date | 2026-01-21 |