| NPI | 1568076495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 14024-RAC) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 14024-RAC) |
| Enumeration Date | 2020-09-08 |
| Last Update Date | 2022-03-03 |