| NPI | 1356168173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1546350124) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2024-09-23 |
| Last Update Date | 2025-03-17 |