NPI | 1376070490 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-CAZSPQ) |
Enumeration Date | 2017-05-19 |
Last Update Date | 2023-07-13 |