| NPI | 1619436979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 21-05-10147) |
| Additional Taxonomies | 106S00000X Behavior Technician |
| Enumeration Date | 2019-03-17 |
| Last Update Date | 2025-05-20 |