| NPI | 1679390272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 25060) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-LVYSMD) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) | |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2025-10-27 |