| NPI | 1437502788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 168131III) | |
| Enumeration Date | 2016-07-21 |
| Last Update Date | 2024-04-04 |