| NPI | 1881381705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 175T00000X Peer Specialist |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: NM CTB-2023-0539) |
| Enumeration Date | 2023-04-20 |
| Last Update Date | 2023-11-11 |