| NPI | 1184401747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: RI CDP00931) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: RI 200866) |
| Enumeration Date | 2023-09-08 |
| Last Update Date | 2025-06-27 |