| NPI | 1215410204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR T-23-2803) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW000002993) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2024-06-05 |