| NPI | 1235482266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C-4563) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA 60327803) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 15-R-27) | |
| 101YM0800X Counselor, Mental Health (Licence: WA 60722084) | |
| Enumeration Date | 2012-10-15 |
| Last Update Date | 2022-12-08 |