| NPI | 1609416627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 22-03-10354) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 19-CRM-301) |
| Enumeration Date | 2020-01-07 |
| Last Update Date | 2022-04-04 |