| NPI | 1356157309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 112146) |
| Enumeration Date | 2024-12-05 |
| Last Update Date | 2025-08-13 |