| NPI | 1427417500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 12-CRM-074) |
| Enumeration Date | 2016-02-17 |
| Last Update Date | 2022-07-21 |