| NPI | 1063128056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 23632) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 373H00000X Day Training/Habilitation Specialist | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2023-01-24 |
| Last Update Date | 2025-12-11 |