| NPI | 1114329356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 14-06-08) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 12-CRM-042) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2023-09-19 |