| NPI | 1528310026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA K1202230953) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OR 4962) |
| Enumeration Date | 2012-10-08 |
| Last Update Date | 2012-11-15 |