| NPI | 1396487138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 247000000X Technician, Health Information (Licence: WV P7L5E7P3) | |
| 171M00000X Case Manager/Care Coordinator | |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2025-05-03 |