| NPI | 1174333272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-25-5158) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 24-CRM-3982) |
| Enumeration Date | 2025-01-10 |
| Last Update Date | 2025-06-24 |