| NPI | 1457604266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-R-02) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61335275) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CO 6654) | |
| 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHA-I-003318) | |
| Enumeration Date | 2012-10-17 |
| Last Update Date | 2024-10-30 |