| NPI | 1568199669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA 13587) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2024-07-29 |