| NPI | 1467206219 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2024-04-16 |
| Last Update Date | 2025-05-13 |