| NPI | 1972285682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-23-3290) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 23-CRM-2206) |
| Enumeration Date | 2023-08-02 |
| Last Update Date | 2023-11-09 |