| NPI | 1568241412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NC CADC-30848) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NC M2023-10648-01) |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2025-06-11 |