| NPI | 1447383070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii5251214) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA Aii5251214) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2019-01-10 |