| NPI | 1003325200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-20-391) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 14-CRM-024) |
| 175T00000X Peer Specialist (Licence: OR THW000000864) | |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2021-07-06 |