| NPI | 1194492041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-ACLC-LIC-55653) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: MT BBH-BHPS-CRT-50097) |
| Enumeration Date | 2021-08-27 |
| Last Update Date | 2022-05-17 |