| NPI | 1043400591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA Go412291733) |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2019-01-15 |