| NPI | 1467977835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor (Licence: CA F5743033) |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA F5743033) | |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2023-06-12 |