| NPI | 1386529238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 20800) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-YKQVPF) |
| Enumeration Date | 2025-08-09 |
| Last Update Date | 2025-11-05 |