| NPI | 1316439250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: CA MPSS-XURHMY) |
| Additional Taxonomies | 373H00000X Day Training/Habilitation Specialist |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 0751) | |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2026-01-02 |