| 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 |