| NPI | 1205960432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR c2282) |
| 101YP2500X Counselor, Professional (Licence: OR c2282) | |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2023-10-22 |