| NPI | 1144630799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 374700000X Technician (Licence: CA RCAS-I 13533) |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2021-08-04 |