| NPI | 1265608764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: UT 1183) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 6850166-6006) |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2025-02-05 |