| NPI | 1023705605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-25-5551) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR N24-CRM-II-0200) |
| Enumeration Date | 2023-04-24 |
| Last Update Date | 2025-07-31 |