| NPI | 1043812571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1421180321) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 171M00000X Case Manager/Care Coordinator (Licence: CA R1421180321) | |
| Enumeration Date | 2020-11-10 |
| Last Update Date | 2024-04-16 |