| NPI | 1376110106 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-02-10633) |
| Additional Taxonomies | 405300000X Prevention Professional (Licence: OR THW000104154) |
| Enumeration Date | 2021-06-09 |
| Last Update Date | 2023-02-08 |