| NPI | 1174302897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 164X00000X Licensed Vocational Nurse (Licence: CA 703378) | |
| Enumeration Date | 2023-09-22 |
| Last Update Date | 2024-06-13 |