| NPI | 1720587553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 405300000X Prevention Professional (Licence: OR 17-CRM-217) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 17-CRM-217) |
| 175T00000X Peer Specialist (Licence: OR THW000002415) | |
| Enumeration Date | 2018-02-07 |
| Last Update Date | 2020-07-23 |