| NPI | 1164582896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 08-06-73) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA RC00052879) |
| 171M00000X Case Manager/Care Coordinator (Licence: OR QMHA) | |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2012-11-16 |