| NPI | 1801401963 |
|---|---|
| Former Name | MANUEL GAMBINO |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1389220520) |
| Enumeration Date | 2020-09-14 |
| Last Update Date | 2021-12-07 |