| NPI | 1477911477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 17-04-13) |
| Additional Taxonomies | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 15-01-09) |
| 101YM0800X Counselor Mental Health (Licence: OR 19-QMHA-I-00297) | |
| 101YM0800X Counselor Mental Health | |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2019-07-11 |