| NPI | 1043083546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 24-06-30113) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHP-001190) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2024-06-15 |