NPI | 1336718410 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 7840233) |
Additional Taxonomies | 175T00000X Peer Specialist |
Enumeration Date | 2021-06-22 |
Last Update Date | 2021-08-18 |