| NPI | 1558767061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA A05781218) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A0507811218) | |
| 172V00000X Community Health Worker (Licence: CA A050781218) | |
| Enumeration Date | 2014-11-10 |
| Last Update Date | 2025-05-13 |