| NPI | 1437915725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-23-3018) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 24-QMHA-R-4985) |
| 175T00000X Peer Specialist (Licence: OR 22-CRM-1246) | |
| Enumeration Date | 2024-02-23 |
| Last Update Date | 2024-02-23 |