| NPI | 1326611914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-1385) |
| Additional Taxonomies | 247200000X Technician, Other |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2022-02-28 |