| NPI | 1124421896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA 143794 I) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2017-03-27 |