| NPI | 1306357165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA CI38460423) |
| Enumeration Date | 2017-10-19 |
| Last Update Date | 2024-04-16 |