| NPI | 1295759199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: CA AC 10786) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2018-02-15 |