| NPI | 1235774043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 241020496) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHA-000169) |
| 175T00000X Peer Specialist (Licence: OR 20-CRM-II-005) | |
| Enumeration Date | 2019-11-15 |
| Last Update Date | 2025-04-16 |