| NPI | 1235953209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR 24-CRM-3222) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-4744) |
| Enumeration Date | 2024-11-14 |
| Last Update Date | 2024-12-18 |