NPI | 1962780270 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LCi04810217) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A9530813) |
171M00000X Case Manager/Care Coordinator (Licence: CA LCi04810217) | |
Enumeration Date | 2011-08-03 |
Last Update Date | 2024-04-11 |