| NPI | 1467043513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR A13552) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 23-11-10964) |
| Enumeration Date | 2021-02-01 |
| Last Update Date | 2024-01-31 |