| NPI | 1235785502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR 3210) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 20-06-24) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 18-CRM-206) | |
| 101YM0800X Counselor, Mental Health (Licence: OR 25-QMHA-I-005159) | |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2025-08-20 |