| NPI | 1962134189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 14926) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: CA MPSS-COSAFV) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2025-11-04 |