| NPI | 1366920704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW000002886) |
| 247000000X Technician, Health Information | |
| Enumeration Date | 2018-07-28 |
| Last Update Date | 2020-10-30 |