| NPI | 1881582872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 24234) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-YHJEVK) |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2026-06-04 |