| NPI | 1972800613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA A3201108) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA LCi04020315) | |
| Enumeration Date | 2011-02-15 |
| Last Update Date | 2024-04-16 |