| NPI | 1275025892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA 20609) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1291780218) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2025-09-15 |