| NPI | 1902474729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 4727) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA 4727) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2024-05-09 |