| NPI | 1346771292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 122898 III) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2018-12-21 |