| NPI | 1871688895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 246RP1900X Technician, Pathology, Phlebotomy (Licence: CA CPT11532) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2007-07-08 |