| NPI | 1578173159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA A054360325) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner (Licence: CA A054360325) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2020-08-07 |
| Last Update Date | 2026-09-21 |