| NPI | 1629702402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1558580424) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 172V00000X Community Health Worker | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-07-15 |
| Last Update Date | 2026-03-27 |