| NPI | 1982207429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 175T00000X Peer Specialist | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| Enumeration Date | 2020-11-18 |
| Last Update Date | 2020-11-18 |