| NPI | 1497394688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1350540619) |
| 101YM0800X Counselor, Mental Health (Licence: CA R1350540619) | |
| Enumeration Date | 2020-01-05 |
| Last Update Date | 2022-02-14 |