| NPI | 1811455132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA DomesticViolence) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA CP40793C1009) |
| 101Y00000X Counselor (Licence: CA 65387) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA H0905301608) | |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2019-03-05 |