| NPI | 1588127336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner (Licence: CA A049600518) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A049600518) |
| 171M00000X Case Manager/Care Coordinator (Licence: CA A049600518) | |
| 225C00000X Rehabilitation Counselor (Licence: CA A049600518) | |
| Enumeration Date | 2019-04-09 |
| Last Update Date | 2019-04-09 |