| NPI | 1447465273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CA PA18570) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2025-09-11 |