| NPI | 1053861393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1237300816) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA R1237300816) |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2016-10-11 |