| NPI | 1154635183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 02-07-31) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 20-QMHP-R-0444) |
| Enumeration Date | 2010-08-02 |
| Last Update Date | 2020-11-13 |