| NPI | 1629792189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA R1480760922) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1480760922) |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2023-04-08 |