| NPI | 1356841076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 18-09-40) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHA-I-00673) |
| 175T00000X Peer Specialist (Licence: OR 16-CRM-084) | |
| Enumeration Date | 2018-02-19 |
| Last Update Date | 2019-10-03 |