| NPI | 1538619069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 372600000X Adult Companion |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-17-256) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2016-10-07 |
| Last Update Date | 2018-06-12 |