| NPI | 1467734590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 10302) |
| Enumeration Date | 2011-09-14 |
| Last Update Date | 2024-04-15 |