| NPI | 1821208208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: MT BBH-LAC-LIC-1082) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: MT BBH-BHPS-CRT-78947) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2025-07-02 |