| NPI | 1063644920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: CA 00232032) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 00232032) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 00232032) | |
| 174H00000X Health Educator (Licence: CA 00232032) | |
| 101Y00000X Counselor (Licence: CA 00232032) | |
| Enumeration Date | 2009-08-11 |
| Last Update Date | 2011-10-21 |