| NPI | 1184327256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KS 01994) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 1869) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MO 13865) | |
| 175T00000X Peer Specialist (Licence: MO 18711) | |
| Enumeration Date | 2023-03-27 |
| Last Update Date | 2026-05-30 |