| NPI | 1467004648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health (Licence: CA 6310) |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2019-07-09 |
| Last Update Date | 2020-11-25 |