| NPI | 1770583304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: CA PA17700) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2021-11-16 |