| NPI | 1730647975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 1730647975) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 175T00000X Peer Specialist (Licence: OR 1730647975) | |
| Enumeration Date | 2019-03-06 |
| Last Update Date | 2024-10-29 |