| NPI | 1508391434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR R7374) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 02-03-60) |
| Enumeration Date | 2017-04-28 |
| Last Update Date | 2022-02-08 |