| NPI | 1851424345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC1900X Psychologist, Counseling (Licence: CA PSY24187) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A3555189) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2011-07-29 |