| NPI | 1659024479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR T-22-1786) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 23-QMHA-I-004017) |
| 172V00000X Community Health Worker (Licence: OR 22-CRM-824) | |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2024-01-10 |