| NPI | 1457739617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii055200418) |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2015-05-08 |
| Last Update Date | 2026-07-22 |