NPI | 1760812531 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: CA LPC 361) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CATC IV 92343) |
Enumeration Date | 2013-11-15 |
Last Update Date | 2013-11-15 |