| NPI | 1609346402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 373H00000X Day Training/Habilitation Specialist (Licence: CA Bii00640223) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: CA Bii00640223) |
| 172V00000X Community Health Worker | |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Bii00640223) | |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2025-04-02 |