| NPI | 1275867749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C2348) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 07-09-29) |
| 103TC1900X Psychologist, Counseling (Licence: OR C2348) | |
| Enumeration Date | 2009-09-30 |
| Last Update Date | 2022-02-08 |