| NPI | 1487334512 |
|---|---|
| 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) |
| 171M00000X Case Manager/Care Coordinator (Licence: CA R1511440623) | |
| Enumeration Date | 2023-07-24 |
| Last Update Date | 2024-09-04 |