| NPI | 1740455849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA MO403021116) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA Mo403021116) |
| 320800000X Community Based Residential Treatment Facility, Mental Illness (Licence: CA MO403021116) | |
| Enumeration Date | 2008-04-29 |
| Last Update Date | 2008-04-29 |