| NPI | 1144887431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1335570119) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA Ci38100423) |
| Enumeration Date | 2019-05-22 |
| Last Update Date | 2025-05-20 |