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 |