| NPI | 1598067555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TA0400X Psychologist Addiction (Substance Use Disorder) (Licence: CA 25588) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA MFC 48997) |
| Enumeration Date | 2010-11-24 |
| Last Update Date | 2016-05-19 |