| NPI | 1609234632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: OR 10-09-71) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OR G 10- P-01) |
| 171M00000X Case Manager/Care Coordinator (Licence: OR 21-QMHA-I-003223) | |
| 175T00000X Peer Specialist (Licence: OR 21-CRM-714) | |
| Enumeration Date | 2016-02-04 |
| Last Update Date | 2022-06-30 |