| NPI | 1255538583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA PCCI1167) |
| Additional Taxonomies | 101Y00000X Counselor |
| 251S00000X | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RAS-L1009232159) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2016-03-28 |