| NPI | 1972364727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-23-2633) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: 23-CRM-1965) |
| Enumeration Date | 2024-01-18 |
| Last Update Date | 2024-01-18 |