| NPI | 1700103314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA 92438) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA 92438) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 92438) | |
| 101YP2500X Counselor, Professional (Licence: CA 92438) | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2018-10-31 |