| NPI | 1497464853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 324500000X Substance Abuse Rehabilitation Facility (Licence: CA R1454361221) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1454361221) | |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2022-11-15 |
| Last Update Date | 2026-02-03 |