| NPI | 1780321380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-1646) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| Enumeration Date | 2022-05-16 |
| Last Update Date | 2022-12-15 |