NPI | 1760002570 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
175T00000X Peer Specialist | |
Enumeration Date | 2020-04-22 |
Last Update Date | 2024-02-20 |