| NPI | 1609260801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 18-03-25) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 15-CRM-022) |
| 175T00000X Peer Specialist (Licence: OR THW0263) | |
| 175T00000X Peer Specialist (Licence: OR 16-PRC-004) | |
| Enumeration Date | 2015-03-25 |
| Last Update Date | 2018-04-17 |