| NPI | 1205404795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-18-552) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 12-CRM-19) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2021-11-23 |