| NPI | 1861293102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist (Licence: VA 0735001034) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: VA 0711000695) |
| Enumeration Date | 2025-03-22 |
| Last Update Date | 2025-03-25 |