| NPI | 1619853348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225400000X Rehabilitation Practitioner |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 23424) |
| 175T00000X Peer Specialist (Licence: CA MPSS-SHFUET) | |
| Enumeration Date | 2025-08-15 |
| Last Update Date | 2025-11-20 |