| NPI | 1417603036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: MPSS-UFGIKE) |
| Enumeration Date | 2022-02-22 |
| Last Update Date | 2025-04-29 |