| NPI | 1295515229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-ICUAQD) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA D9707467) |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2025-01-13 |