NPI | 1376108654 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA R1240091216) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1240091216) |
Enumeration Date | 2019-05-02 |
Last Update Date | 2019-05-07 |