| NPI | 1033596853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 11-CRM-002) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 05-11-97) |
| Enumeration Date | 2015-04-30 |
| Last Update Date | 2015-04-30 |