| NPI | 1366034092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 1478) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2021-02-04 |
| Last Update Date | 2024-11-22 |