| NPI | 1881173888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 19-CRM-077) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2023-07-20 |