| NPI | 1154076370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA Ci4270524) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1458280222) |
| 172V00000X Community Health Worker | |
| 175T00000X Peer Specialist | |
| 175T00000X Peer Specialist (Licence: CA MPSS-TBYHIP) | |
| Enumeration Date | 2022-02-16 |
| Last Update Date | 2024-09-13 |