| NPI | 1649848656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 21-06-10177) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 19-CRM-170) |
| 101YM0800X Counselor, Mental Health (Licence: OR 22-QMHA-I-003506) | |
| Enumeration Date | 2021-06-15 |
| Last Update Date | 2025-01-31 |