| NPI | 1720450836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1219871215) | |
| Enumeration Date | 2015-10-28 |
| Last Update Date | 2022-09-19 |