| NPI | 1699274068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: KY 296360) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2018-02-12 |
| Last Update Date | 2025-02-17 |