| NPI | 1144361924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 09- R-15) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHPC-00775) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP00006216) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2020-02-12 |