| NPI | 1902199946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: 19-QMHA-I-01590) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 15-05-31) |
| Enumeration Date | 2011-05-24 |
| Last Update Date | 2020-10-22 |