| NPI | 1255787644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 15-CRM-181) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW0001268) |
| Enumeration Date | 2016-05-04 |
| Last Update Date | 2022-02-10 |