| NPI | 1942506811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA A051970820) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-WJIHQS) |
| Enumeration Date | 2011-02-09 |
| Last Update Date | 2024-09-24 |