| NPI | 1992438048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: UT 14185548-6006) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: UT 1840) |
| 171M00000X Case Manager/Care Coordinator (Licence: UT 1840) | |
| Enumeration Date | 2022-07-06 |
| Last Update Date | 2026-04-17 |