| NPI | 1235785502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 18-CRM-206) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 20-06-24) |
| Enumeration Date | 2019-08-13 |
| Last Update Date | 2024-08-21 |