| NPI | 1699276550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 17-CRM-187) |
| Enumeration Date | 2018-02-26 |
| Last Update Date | 2022-01-06 |