NPI | 1457707317 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-19-202) |
Additional Taxonomies | 175T00000X Peer Specialist |
Enumeration Date | 2016-05-10 |
Last Update Date | 2019-06-20 |