| NPI | 1104699099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-2156) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHA-R-4572) |
| 175T00000X Peer Specialist (Licence: OR 23-CRM-2525) | |
| Enumeration Date | 2023-11-01 |
| Last Update Date | 2024-06-17 |