| NPI | 1487341822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CADC-26357) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NC 2023-6377-01) |
| Enumeration Date | 2023-04-18 |
| Last Update Date | 2023-04-18 |