| NPI | 1225709736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-21-598) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 22-CRM-826) |
| 175T00000X Peer Specialist (Licence: OR THW000106269) | |
| Enumeration Date | 2021-09-23 |
| Last Update Date | 2022-10-20 |