| NPI | 1598773608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OR C1884) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C1884) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 061188U3) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2007-07-08 |