| NPI | 1467220236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 24-07-20450) | |
| Enumeration Date | 2023-12-12 |
| Last Update Date | 2025-01-15 |