| NPI | 1043967573 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-07-24) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OR 19-07-24) |
| Enumeration Date | 2022-03-04 |
| Last Update Date | 2023-03-17 |