| NPI | 1770939720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA Aii055750518) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2024-04-15 |