| NPI | 1568154623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1624500725) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2025-07-29 |