| NPI | 1063198885 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA R1528420923) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1528420923) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA R1528420923) | |
| Enumeration Date | 2023-06-26 |
| Last Update Date | 2024-04-30 |