| NPI | 1477699429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 08-12-77) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR C2378) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2022-03-07 |