| NPI | 1770297129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-21-907) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 22-CRM-II-0043) |
| Enumeration Date | 2023-01-10 |
| Last Update Date | 2023-01-10 |