| NPI | 1891508727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 0002784) |
| Additional Taxonomies | 104100000X Social Worker (Licence: CO 0000002400) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2025-01-27 |
| Last Update Date | 2025-08-06 |