| NPI | 1851656813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: AZ 12894) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: AZ 11731) | |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2026-03-18 |