| NPI | 1427270735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA CAADE#020515) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 52625 (INTERN NUMBER) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2007-07-08 |