| NPI | 1407728751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Ci-32290321) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: CA 9BF2513B53) |
| 175T00000X Peer Specialist (Licence: CA MPSS-MRDHNE) | |
| Enumeration Date | 2025-09-18 |
| Last Update Date | 2025-09-18 |