| NPI | 1295150837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: Mpss-dpkvhu) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA C10261214) | |
| Enumeration Date | 2014-02-19 |
| Last Update Date | 2024-05-02 |