| NPI | 1538603618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C6150) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| 101YP2500X Counselor, Professional (Licence: OR C6150) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OR R4989) | |
| Enumeration Date | 2016-12-08 |
| Last Update Date | 2022-10-25 |