| NPI | 1144796178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR L11633) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 22-06-10445) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2024-01-15 |