| NPI | 1902421712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 175T00000X Peer Specialist |
| 225400000X Rehabilitation Practitioner | |
| Enumeration Date | 2020-06-08 |
| Last Update Date | 2024-07-12 |