| NPI | 1447486139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 02-049232) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 5636) |
| 101YM0800X Counselor, Mental Health (Licence: CA 02-049232) | |
| 101YM0800X Counselor, Mental Health (Licence: CA 5636) | |
| 171M00000X Case Manager/Care Coordinator (Licence: CA 02-049232) | |
| 171M00000X Case Manager/Care Coordinator (Licence: CA 5636) | |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2017-03-29 |