| NPI | 1184068793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OR G 16-04-01) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 12-06-75U) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2016-05-26 |