| NPI | 1114613973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 251K00000X Public Health or Welfare | |
| Enumeration Date | 2023-04-14 |
| Last Update Date | 2023-04-14 |