| NPI | 1164065041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 14576-RAC) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2021-07-27 |