| NPI | 1548187107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: OR 114800) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 26-QMHA-R-9078) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-26-6862) | |
| Enumeration Date | 2026-07-02 |
| Last Update Date | 2026-08-27 |