| NPI | 1316413008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LR05270519) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 13290) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2018-10-19 |
| Last Update Date | 2021-08-30 |