| NPI | 1730915430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA R1578100924) |
| Enumeration Date | 2024-09-10 |
| Last Update Date | 2025-03-24 |