| NPI | 1407003312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 247200000X Technician, Other |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA S1104291427) | |
| Enumeration Date | 2008-08-21 |
| Last Update Date | 2026-01-08 |