| NPI | 1972636603 |
|---|---|
| Former Name | CHARLES DE LA CERDA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A0683425) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2007-07-08 |