| 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 |