| NPI | 1962123125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA CiCA01530719) |
| 171M00000X Case Manager/Care Coordinator (Licence: CA CiCA01530719) | |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2025-02-13 |