| NPI | 1477268001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| Additional Taxonomies | 102X00000X Poetry Therapist |
| 171400000X | |
| 172V00000X Community Health Worker | |
| 174H00000X Health Educator | |
| 175T00000X Peer Specialist | |
| 221700000X Art Therapist | |
| Enumeration Date | 2023-01-18 |
| Last Update Date | 2023-08-14 |