| NPI | 1487791588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 00-11-42) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR G 05-07-02) |
| 101YP2500X Counselor, Professional (Licence: OR C1020) | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |