| NPI | 1124219688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CAADE #200355) |
| Additional Taxonomies | 101Y00000X Counselor |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2018-06-05 |