| NPI | 1609069921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 10-12-70) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: OR C3475) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2021-12-23 |