| NPI | 1548752199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 22-11-20216) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 17-CRM-068) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2024-10-04 |