| NPI | 1003981085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor Mental Health (Licence: OR C2793) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) |
| 101YP2500X Counselor Professional (Licence: OR C2793) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2013-02-01 |