| NPI | 1649506429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 9504) |
| Additional Taxonomies | 347C00000X Private Vehicle |
| 101Y00000X Counselor | |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2013-07-25 |