| NPI | 1619604295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1506190523) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2022-08-04 |
| Last Update Date | 2023-05-06 |