| NPI | 1598198954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C5596) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-17-081) |
| 101YM0800X Counselor, Mental Health | |
| Enumeration Date | 2013-08-20 |
| Last Update Date | 2022-07-07 |