| NPI | 1558123844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-24-3818) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 23-CRM-2658) |
| Enumeration Date | 2024-01-23 |
| Last Update Date | 2025-11-14 |