NPI | 1265572630 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii58330518) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA Aii58330518) |
Enumeration Date | 2007-02-07 |
Last Update Date | 2024-04-15 |