| NPI | 1821791336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: LA 175T00000X) |
| Enumeration Date | 2023-03-23 |
| Last Update Date | 2023-03-24 |