| NPI | 1194542548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-4500) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 25-CRM-4427) |
| Enumeration Date | 2024-09-25 |
| Last Update Date | 2026-04-15 |