NPI | 1467657791 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C2453) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 08-08-32) |
Enumeration Date | 2007-06-18 |
Last Update Date | 2021-01-21 |