| NPI | 1609135136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OR C1953) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 06-03-61) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2012-05-03 |