| NPI | 1770956245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA R1210080815) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA A059780521) |
| Enumeration Date | 2015-11-05 |
| Last Update Date | 2024-06-17 |