| NPI | 1750752010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-18-281) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 106H00000X Marriage & Family Therapist (Licence: CA IMF80598) | |
| 106H00000X Marriage & Family Therapist (Licence: CA 56125) | |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2019-02-13 |