| NPI | 1821691668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 20-CRM-067) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR THW000004376) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2023-01-18 |