| NPI | 1871340885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: CA 24-CCHW-00010) |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RH0011410823) | |
| Enumeration Date | 2024-05-06 |
| Last Update Date | 2024-08-28 |