| NPI | 1346921228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 25-05-11489) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 23-CRM-1667) |
| Enumeration Date | 2023-07-25 |
| Last Update Date | 2026-01-22 |