| NPI | 1609326214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OR 19-QMHA-I-00870) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 18-01-36) |
| Enumeration Date | 2016-10-06 |
| Last Update Date | 2020-05-07 |