| NPI | 1346849155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-CRM-033) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 24-QMHA-R-5810) |
| 175T00000X Peer Specialist (Licence: THW000003482) | |
| Enumeration Date | 2020-10-22 |
| Last Update Date | 2024-09-16 |