| NPI | 1265977888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 17-R-04) |
| 101YM0800X Counselor Mental Health | |
| 101YP2500X Counselor Professional (Licence: OR C6086) | |
| Enumeration Date | 2017-01-05 |
| Last Update Date | 2023-03-31 |