| NPI | 1114362167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R2571014) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2013-05-03 |
| Last Update Date | 2014-12-19 |