| NPI | 1083152508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 16-04-09) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OR 13-CRM-042) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2017-02-03 |