| NPI | 1588806681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA psb 34160) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: CA psb 34160) |
| 103TP2701X Psychologist, Group Psychotherapy (Licence: CA psb 34160) | |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2011-07-06 |