| NPI | 1710536792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 171M00000X Case Manager/Care Coordinator | |
| 171M00000X Case Manager/Care Coordinator (Licence: CA A050701118) | |
| Enumeration Date | 2019-09-11 |
| Last Update Date | 2025-07-02 |