| NPI | 1841799111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R5984) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA R5984) |
| Enumeration Date | 2018-02-01 |
| Last Update Date | 2024-04-25 |