| NPI | 1275105686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 21-CRM-454) |
| Enumeration Date | 2021-07-14 |
| Last Update Date | 2021-11-04 |