| NPI | 1639539562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 16-02-11) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 19-QMHA-I-02656) |
| Enumeration Date | 2016-03-04 |
| Last Update Date | 2022-12-30 |