| NPI | 1952883191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor Mental Health |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 175T00000X Peer Specialist | |
| Enumeration Date | 2018-09-04 |
| Last Update Date | 2020-07-17 |