| NPI | 1134487077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA MV18244) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: CA MV18244) |
| 103K00000X Behavior Analyst (Licence: CA MV18244) | |
| Enumeration Date | 2012-04-29 |
| Last Update Date | 2012-04-29 |