| NPI | 1699663526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: NM CTB-2026-0720) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: NM 1565) |
| Enumeration Date | 2025-06-27 |
| Last Update Date | 2026-08-26 |