| NPI | 1457772634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA CI4210415) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA C0911214) |
| Enumeration Date | 2013-12-14 |
| Last Update Date | 2016-02-09 |