| NPI | 1205274610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RI-T1303131110) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 85329) |
| Enumeration Date | 2013-06-07 |
| Last Update Date | 2015-05-25 |