| NPI | 1386064764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C5136) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 16-06-25) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP60484457) | |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2019-10-16 |