| NPI | 1376834168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA A8567406 CAADAC) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CA 88654472 NASW) |
| Enumeration Date | 2011-04-27 |
| Last Update Date | 2011-06-28 |