| NPI | 1376181982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor Professional (Licence: OR R8733) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR T-19-370) |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2019-12-13 |
| Last Update Date | 2024-03-04 |