| NPI | 1508992678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHA-I-02175) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 04-P-06) |
| Enumeration Date | 2007-02-25 |
| Last Update Date | 2022-06-29 |