| NPI | 1437474285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: CA 1982) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: HI 1368-08) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2016-06-24 |