| NPI | 1578673380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR OR CO947) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA WA LH00004068) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-10-27 |