| NPI | 1346918190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator | |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: CA 6045430733) | |
| Enumeration Date | 2021-09-04 |
| Last Update Date | 2025-07-16 |