| NPI | 1417570227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci28760120) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA Ci28760120) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2024-04-30 |