| NPI | 1235492042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C3323) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 11-09-09) |
| 101YP2500X Counselor, Professional (Licence: OR C3323) | |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2017-01-19 |