| NPI | 1407665292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR 108796) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 26-QMHA-R-8761) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-25-5655) | |
| Enumeration Date | 2025-01-06 |
| Last Update Date | 2026-06-08 |