| NPI | 1053850750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-06-20284) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR G-24-05-1018) |
| 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHA-I-004029) | |
| 175T00000X Peer Specialist (Licence: OR 21-CRM-704) | |
| 175T00000X Peer Specialist (Licence: OR 23-CGRM-020) | |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2024-06-17 |