| NPI | 1972040061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA 19609) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 2114485) | |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2017-01-26 |
| Last Update Date | 2024-12-31 |