| NPI | 1477672699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 01-069225) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 106H00000X Marriage & Family Therapist (Licence: CA 75237) | |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2020-04-09 |