| NPI | 1669770426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA 1135-031613A) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA CORPHQ-1135-031613A) |
| 320800000X Community Based Residential Treatment Facility, Mental Illness | |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 1135-031613A) | |
| Enumeration Date | 2011-03-03 |
| Last Update Date | 2012-06-15 |