| NPI | 1326771924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WV 23-310) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: WV CP00945845) |
| 175T00000X Peer Specialist (Licence: WV 19-1909) | |
| Enumeration Date | 2022-07-01 |
| Last Update Date | 2023-10-13 |