| NPI | 1215322565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA A02460315) |
| Enumeration Date | 2015-04-03 |
| Last Update Date | 2015-09-30 |