NPI | 1184012379 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHP-R-1561) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 06-03-62) | |
Enumeration Date | 2014-12-23 |
Last Update Date | 2024-06-27 |