| NPI | 1033297833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: CA G60409) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC50715) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA MFC50715) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2015-04-06 |