| NPI | 1386882819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RA859209) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: CA ASW 27103) |
| Enumeration Date | 2009-01-21 |
| Last Update Date | 2010-03-06 |