| NPI | 1447144068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 21055) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2025-06-06 |
| Last Update Date | 2025-11-21 |