| NPI | 1225213887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA L0503162001) |
| Enumeration Date | 2008-01-02 |
| Last Update Date | 2010-01-13 |