| NPI | 1700351624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 17812) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: CA 106392) |
| Enumeration Date | 2018-10-07 |
| Last Update Date | 2024-04-09 |