| NPI | 1235590373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 123322 I) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: CA 123322 I) |
| 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: CA 1160024251) | |
| 133N00000X Nutritionist (Licence: CA 1160024251) | |
| Enumeration Date | 2016-03-17 |
| Last Update Date | 2017-03-21 |