| NPI | 1669662045 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA Aii5411214) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: CA CPS0281116) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2007-07-31 |
| Last Update Date | 2017-03-02 |