| NPI | 1093495640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1511500623) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA R1511500623) |
| Enumeration Date | 2023-07-19 |
| Last Update Date | 2024-04-03 |