| NPI | 1598160814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 17-02-14) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 14-08-10) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2023-04-10 |