| NPI | 1114433588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1544610124) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2017-12-21 |
| Last Update Date | 2024-02-27 |