| NPI | 1225487127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 16-CRM-070) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2023-12-18 |