| NPI | 1144366089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 05-07-18) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OR 05-07-18) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-07-08 |