| NPI | 1265218762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-GKTBSF) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1523050823) |
| Enumeration Date | 2023-08-31 |
| Last Update Date | 2024-10-16 |