| NPI | 1659694073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA c031100215) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA c031100215) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 122789) | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2010-03-12 |
| Last Update Date | 2023-05-30 |