| NPI | 1265553598 |
|---|---|
| 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 Ao17610315) |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2020-12-30 |