| NPI | 1457162091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA RT1428330126) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-NOGVSA) |
| Enumeration Date | 2025-01-14 |
| Last Update Date | 2026-02-02 |