| NPI | 1972160810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci09781117) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA A059170121) |
| Enumeration Date | 2019-05-28 |
| Last Update Date | 2024-04-15 |