| NPI | 1225652001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-64263) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: MT 42875) |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2024-05-23 |