| NPI | 1184054710 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 14-07-06) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 17-CRM-II-011) |
| 175T00000X Peer Specialist (Licence: OR THW0001269) | |
| Enumeration Date | 2013-11-18 |
| Last Update Date | 2023-05-18 |