| NPI | 1821537671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: CA Lapsed) |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 10236-R) | |
| Enumeration Date | 2017-02-13 |
| Last Update Date | 2022-11-07 |