| NPI | 1467871939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 01-R-17) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR 01-R-17) |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2021-03-29 |