| NPI | 1518491620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LR01580715) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LR01580715) |
| 101YP1600X Counselor, Pastoral (Licence: CA CAWES1-1-011930SM) | |
| Enumeration Date | 2017-04-14 |
| Last Update Date | 2021-11-08 |