| NPI | 1497393425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR 21-CRM-411) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR CADC-RT-20-486) |
| 171M00000X Case Manager/Care Coordinator (Licence: OR 20-QMHA-R-0842) | |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2021-04-08 |