| NPI | 1508508920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1463270322) | |
| Enumeration Date | 2022-04-07 |
| Last Update Date | 2024-01-23 |