| NPI | 1861939506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101Y00000X Counselor |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-21-555) | |
| Enumeration Date | 2017-01-19 |
| Last Update Date | 2023-08-04 |