| NPI | 1841941499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 17453) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 17453) |
| 175T00000X Peer Specialist | |
| 106S00000X Behavior Technician (Licence: CA R1404530920) | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2022-01-14 |
| Last Update Date | 2026-08-06 |