| NPI | 1790527273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 19724) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2024-06-06 |
| Last Update Date | 2025-03-13 |