| NPI | 1336978196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 103TA0400X Psychologist, Addiction (Substance Use Disorder) |
| 171400000X Health & Wellness Coach | |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2024-07-30 |
| Last Update Date | 2024-07-31 |