| NPI | 1316712326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 302027) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2026-05-05 |