| NPI | 1932088648 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 175T00000X Peer Specialist | 
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) | 
| Enumeration Date | 2025-08-27 | 
| Last Update Date | 2025-08-27 |