NPI | 1497380406 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: CA E1055877) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
172V00000X Community Health Worker | |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA E1055877) | |
Enumeration Date | 2020-03-10 |
Last Update Date | 2024-04-17 |