| NPI | 1023483583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 15-02-05) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C4282) |
| 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: OR C4282) | |
| Enumeration Date | 2015-12-09 |
| Last Update Date | 2017-10-31 |