| 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 |