| NPI | 1295327146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1423090321) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-JKYHQE) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2021-02-10 |
| Last Update Date | 2026-03-16 |